Post partum contraception

Here are six key contraception tips for optimal postpartum care:

Initiate discussion of ongoing contraceptive needs while the patient is still pregnant and encourage her to communicate these to her clinical attendants Provide an evidence-based discussion of the pros and cons of various contraceptive methods — taking care to counter prevailing misconceptions If the choice is oral contraception, provide her with a prescription so that she can commence this immediately postpartum. It is a detail often overlooked at hospital discharge If the choice is for an IUD or implant, then ensure that she takes the device along to the hospital with her. Few hospitals or outpatient departments have these devices on hand or provide them cost-free. If she does not bring one along, she is likely to be rescheduled even if there are no contraindications to insertion at the time Be aware of the virtues of bridging contraception. If access to her preferred contraceptive method is likely to be delayed, then provide her with something until she can get it — such as the POP, DPMA or COCP, if she is not breastfeeding Encourage her to come back to discuss her options before simply stopping a method which is not suiting her.

A mnemonic for rheumatic fever: Jones major criteria: JONES:

• Joints (polyarthritis)
• Obvious (i.e. cardiac criterion: carditis)
• Nodules (subcutaneous)
• Erythema marginatum
• Sydenham’s chorea

If you see a right bundle branch block (RBBB) on an ECG,  look also for a left anterior fascicular block (LAFB).

ECG findings of left anterior fascicular block (LAFB):

• Left axis deviation, i.e. mean frontal QRS axis between -30 and -90 degrees;
• qR in aVL and usually I;
• rS in III and aVF.

Kerley B lines on the chest x-ray of a patient not responding to management of pulmonary edema? Think lymphangitic carcinomatosis.

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AMC EXAM HELP

PSYCHIATRY

Psychiatry MCQ




PSYCHIATRY





1.A 34 year old lady with a previous divorce now comes to you with a seductive behaviour



a. Narcistic

b. Histrionic

c. Borderline

d. Panaroid

e lack of insight



2.A 23 year old man set up fire deliberately. Which is true regarding pyromaniacs?



a. Done for notoriety or publicity

b. To hide their acts

c. As they like to play with fire

d. Set fire and get panic attacks

e. For satisfaction



3.A 23 year old man presented with depersonalization, this may occur in



a. Schizophrenia

b. Ecstatic religious experience

c. Depression

d. Post traumatic disorder

e. All of the above



4.A middle aged lady present to you with nausea dyspepsia abdominal distention. She had a past history of going to many doctors and being treated for many disorders. she has been treated by a rheumatologist for aches and pains, cardiologist for her palpitations and gave her propanolol without improvement , a neurologist for her epilepsy. On examination you find a tense anxious woman in spite of her daily dose of benzodiazepine. There are scar from appendectomy and hysterectomy operations. What is the most appropriate diagnosis?



a. Munchausen syndrome

b. Conversion disorder

c. Hypochondriasis

d. factitious disorder,

e. Neurotic anxiety



5.Many psychopharmacologic substance are lipophilic the advantage is



a. better absorbed with meals

b. promptly binds with free fatty acids

c. more resistant to be metabolized by thae liver

d. the pass rapidly to the brain and to the blood

e. a drug which has a long life and needs to be given once a day daily



6. Regarding of lithium medications, which of the following is true ?



a. loses it effectiveness over the time

b. is non addictive

c. works better in women than men

d. interaction with NSAIDS



7. Which of the following is morbid jealousy ?



a. alcoholism

b. schizophrenia

c. depression

d. obsessive compulsive

e. mania



8. A 40 year old male school teacher who has recently separated from his wife was; prescribed imipramine 25 mg for his depression. He had a road accident in which he hurt his child. He was admitted to hospital for taking an overdose of imipramine with alcohol. He does not give consent to go for psychiatric counselling or to be admitted hospital for further treatment. Your next step in the management of this patient is:



a. Ask him to go to alcoholics anonymous

b. Increase the dose of Amitriptyline to 125 mg and send him home

c. Change to another drug

d. Retain him in the hospital against his using he Mental health act

e. Contact his wife and try to persuade her to return to him

f. Alcohol counselling